{
  "abstract": "Objective To investigate the effectiveness of maintenance interventions postexercise therapy on physical activity (PA), physical function, fitness, health-related quality of life, adverse events, hospitalisation and return to work in people with chronic conditions.Design In this umbrella review, a narrative synthesis was conducted. Risk of bias was assessed using the Risk of Bias in Systematic Reviews tool. The quality and certainty of evidence were evaluated using Grading of Recommendation, Assessment, Development and Evaluation.Data sources Medline, Embase and CINAHL were searched from inception to 20 August 2024.Eligibility criteria Systematic reviews of randomised controlled trials (RCTs) investigating the effectiveness of maintenance interventions following exercise therapy in people with chronic conditions.Results From 10 931 results, 19 systematic reviews (136 unique RCTs) were included. Reviews included people with chronic respiratory disease (n=64), cardiovascular disease (n=54), chronic low back pain (n=4) or knee/hip osteoarthritis (n=14). Most reviews had an unclear risk of bias (n=10). We identified three types of maintenance interventions based on delivery mode: primarily digital, primarily inperson and a mixed category comprising exclusively digital, inperson or hybrid delivery. Beneficial effects were found for digital health interventions on subjective PA (standardised mean difference (SMD) 0.37, 95% CI 0.05 to 0.69, low certainty), but no beneficial effects were found for inperson booster sessions (very low to low certainty). Mixed maintenance interventions showed beneficial effects for health-related quality of life (MD 0.28 points 95% CI 0.05 to 0.52; SMD 0.22 95% CI 0.03 to 0.41; MD −2.69 points 95% CI −4.49 to −0.9; moderate certainty), objective PA (SMD 2.14 95% CI 0.9 to 3.38, low certainty) and objective physical function (SMD 0.48 95% CI 0.19 to 0.77, low certainty). We found no effect or inconsistent effects for fitness, adverse events, hospitalisation and return-to-work (low to moderate certainty).Conclusion Maintenance interventions may help people continue to be physically active and improve physical function and health-related quality of life. However, this is based on low certainty of evidence. The remaining outcomes were generally inconsistent or indicated no effects. Digital maintenance interventions show some beneficial effects for PA but higher-quality studies are needed across various chronic conditions.PROSPERO registration number CRD42024579734.",
  "authors": [
    {
      "affiliations": [
        "Centre for Health Research, Zealand University Hospital, Nykøbing Falster, Denmark",
        "The Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved Slagelse and Ringsted Hospitals, Slagelse, Region Zealand, Denmark"
      ],
      "name": "Alexander Luijk"
    },
    {
      "affiliations": [
        "Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark"
      ],
      "name": "Alessio Bricca"
    },
    {
      "affiliations": [
        "The Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved Slagelse and Ringsted Hospitals, Slagelse, Region Zealand, Denmark",
        "Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark"
      ],
      "name": "Sofie Rath Mortensen"
    },
    {
      "affiliations": [
        "The Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved Slagelse and Ringsted Hospitals, Slagelse, Region Zealand, Denmark",
        "Center for Surgery, National Hospital of the Faroe Islands, Tórshavn, Faroe Islands",
        "Faculty of Health Sciences, University of Faroe Islands, Tórshavn, Faroe Islands"
      ],
      "name": "Pætur Holm"
    },
    {
      "affiliations": [
        "The Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved Slagelse and Ringsted Hospitals, Slagelse, Region Zealand, Denmark"
      ],
      "name": "Graziella Zanger"
    },
    {
      "affiliations": [
        "The Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved Slagelse and Ringsted Hospitals, Slagelse, Region Zealand, Denmark",
        "Department of Regional Health Research, University of Southern Denmark, Odense, Denmark"
      ],
      "name": "Charlotte Simonÿ"
    },
    {
      "affiliations": [
        "The Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved Slagelse and Ringsted Hospitals, Slagelse, Region Zealand, Denmark",
        "Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark"
      ],
      "name": "Søren T Skou"
    },
    {
      "affiliations": [
        "Centre of Social Medicine, University Hospital Bispebjerg-Frederiksberg, Frederiksberg, Denmark",
        "Department of Occupational and Social Medicine, University of Copenhagen Department of Public Health, Copenhagen, Capital Region of Denmark, Denmark"
      ],
      "name": "Thomas Lund"
    },
    {
      "affiliations": [
        "The Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved Slagelse and Ringsted Hospitals, Slagelse, Region Zealand, Denmark",
        "Department of Regional Health Research, University of Southern Denmark, Odense, Denmark"
      ],
      "name": "Lars Hermann Tang"
    }
  ],
  "title": "Effectiveness of maintenance interventions promoting physical activity following exercise therapy for chronic conditions: an umbrella review",
  "uid": "4a4d9172-f91a-5963-9196-654fb2d87a93"
}